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(Hypertension. 2008;51:179.)
© 2008 American Heart Association, Inc.

Editorial Commentaries

Assessing Left Ventricular Performance

A Rashomon Effect

Giovanni de Simone; Richard B. Devereux

From Department of Clinical and Experimental Medicine (G.d.S.), Federico II University, Naples, Italy; and Weill-Cornell Medical College (R.B.D.), New York, NY.

Correspondence to Giovanni de Simone, Department of Clinical and Experimental Medicine, Federico II University Hospital, v.S.Pansini 5, 80131 Naples, Italy. E-mail simogi@unina.it

An extract of the first 250 words of the full text is provided, because this article has no abstract.

	Introduction

 
The physiology of conduit arteries can be approximated noninvasively. One simple method to estimate arterial load is by computation of effective arterial elastance (E_a). E_a incorporates the steady component (peripheral resistance) and the pulsatile components of arterial load, including total arterial compliance and aortic characteristic impedance. Invasive studies and simulations have shown that E_a can be approximated by the ratio of left ventricular (LV) end-systolic pressure to stroke volume in normal and hypertensive human subjects.^1,2 An important practical advantage of the calculation of E_a is the merging of all components of arterial load into a single quantitative variable, although it has the limitations of not separating the relative contributions of steady and pulsatile components² and of relative sensitivity to variation of heart rate.³

E_a influences stroke volume and is related to LV contractility, as assessed at end ejection by the pressure-volume loop and determination of the LV elastance (E_max).^4,5 Thus, E_a has been combined with E_max, the slope of a regression line connecting end-systolic pressures and volumes obtained at different loading conditions. The ratio E_a/E_max is widely used as a measure of LV-arterial coupling. As emphasized recently by Baicu et al,⁶ LV function, LV performance, LV contractility, and myocardial contractility are not interchangeable terms. Experimental studies suggest that LV performance, measured as stroke work (SW),⁶ is maximal when E_max=E_a. LV performance increases its efficiency when, for a given SW, myocardial oxygen consumption is lower. The optimal efficiency of LV performance is achieved at E_a. . . [Full Text of this Article]

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